Office Hours 1

Essentials of Global Health is a comprehensive introduction to global health. It is meant to introduce you to this topic in well-structured, clear and easy to understand ways. Much of the course will focus on five questions: What do people get sick, disabled and die from; Why do they suffer from these conditions? Which people are most affected? Why should we care about such concerns? What can be done to address key health issues, hopefully at least cost, as fast as possible, and in sustainable ways? The course will be global in coverage but with a focus on low- and middle-income countries, the health of the poor, and health disparities. Particular attention will be paid throughout the course to health systems issues, the linkages between health and development, and health matters related to global interdependence. The course will cover key concepts and frameworks but be practical in orientation.
ESSENTIALS OF GLOBAL HEALTH WAS PRODUCED IN PART DUE TO THE GENEROUS FUNDING OF THE DAVID F. SWENSEN FUND FOR INNOVATION IN TEACHING.
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Course Learning Objectives
By the end of the course, learners should be able to:
• Articulate key public health concepts related to global health;
• Analyze the key issues in global health from a number of perspectives;
• Discuss with confidence the burden of disease in various regions of the world; how it varies by sex, age, and location; key risk factors for this burden; and how the disease burden can be addressed in cost-effective ways;
• Assess key health disparities, especially as they relate to the health of low-income and marginalized people in low- and middle-income countries;
• Outline the key actors and organizations in global health and the manner in which they cooperate to address critical global health concerns;
• Review key global health challenges that are likely to arise in the coming decades.
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Value Added of the Course
The course seeks to add special value by being comprehensive, by handling each topic in a consistent framework, and by helping learners gain an understanding of well grounded approaches to assessing global health issues and what can be done to address them.
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The Readings and other materials for Essentials of Global Health
For almost every session of Essentials of Global Health, you will see:
- Required readings
- Recommended readings
- Recommended videos
We have selected a small number of readings for each session that are central to understanding the content of the session. We have put these under “required readings”.
For each required reading, we have also indicated how carefully you should read the material and on what parts of the material you should focus your attention.
In addition, we have selected some additional readings that would be very helpful to your understanding the content of each session.
The first is a textbook, Global Health 101, third edition. This is a comprehensive introductory textbook that closely follows the content of this Essentials of Global Health course. We have indicated for each session what part of the book you should read. Using this textbook can be very valuable to your mastering the content of the course.
The second set of “recommended readings” is some additional readings, mostly from journal articles and reports. For these, too, we have indicated how carefully you should read the material and on what parts of the material you should focus your attention.
Learners should note that to access articles from The Lancet they will have to register with the Lancet, if they do not have online access to a library that has The Lancet. Once they are registered, they will be able to sign into The Lancet and access all of its free articles.
We have also indicated for most sessions one or two videos that relate to the topic of the session. These are meant to help the learner get a better feel for the topic which is being covered. Most learners will find the videos brief, easy and enjoyable to watch, and very enlightening.

教学方

Richard Skolnik

Former Lecturer, Department of Health Policy and Management, Yale School of Public Health and Lecturer in the Practice of Management, Yale School of Management, 2012-2016

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Welcome to our first office hours for "Essentials of Global Health." I can't thank you enough for submitting so many interesting and thoughtful questions. And today, what we're going to try to do is answer six of those questions which learners have voted as among the most important ones they'd like to see us try to answer. I can't thank enough my former student, Rachel Strudel (?), who is now actually working with me as a research assistant, who's going to assist us in carrying out what we hope will be an interesting and engaging office hours for you. So, Rachel, please go ahead. I'm completely at your disposal. Wonderful. Our first question from a learner is as follows, "Global health, public health, and international health are related to one another. Where are the differences and where are the similarities?" Thank you for this valuable question about which there is a lot of confusion, and some important differences of view. I'm going to read the formal definition of public health if I might. "Public health is the science of protecting and improving the health of families and communities through promotion of healthy lifestyles, research for disease and injury prevention, and detection and control of infectious diseases. Overall, public health is concerned with protecting the health of entire populations." Now, the term "international health" is actually not used very much anymore. In general, it was used to refer to health issues outside of one's own country, and it was also used to refer to the study of health in low and middle-income countries. The term "global health" has largely replaced the older term international health. This term, global health, is meant to imply, importantly, a shared interest among all countries in the health of each other. It's also meant to imply, cooperation across countries to solve problems. In the end, I'm not sure I'd worry that much about what the formal definition of global health is. And in the end, there is not complete agreement about what that definition is. However, most people agree that global health is an area of public health work that focuses on issues that transcend national boundaries, and that it involves co-operative efforts to achieve what we call "health for all." Rachel, I hope that's okay and I'm ready for another one. Sure. Our next question is, "Can you touch on how some health-related behaviors, such as hand-washing, condom use, breastfeeding, and physical activity, are closely tied to social norms, culture, laws and religion, and their relation with health?" Indeed, the links between culture and health are exceptionally strong, as everyone knows. The age of sexual debut, the place of woman in society, the age of first birth, for example, are intimately linked with local cultural practices. What we eat, how much we eat, who eats first, are also linked closely with culture. Attitudes toward contraception, breastfeeding, tobacco and alcohol consumption, and intimate partner violence are all heavily bound with culture. And it's also true that many health-related behaviors are associated with religious custom. Although there is very interesting evidence that suggests that, the strength of religious practice may be as important as the religion you follow especially, for example, for beliefs about family size and the use of contraception. Now, although the answer may seem trite, the evidence suggests that changing behavior requires an intimate understanding of why people behave in certain ways. Some behavior change with respect, for example, to female genital mutilation, or intimate partner violence, will almost certainly have to be community-based and led by respected people who can mobilize change within a community. This was also true, for example, of getting communities in North India and in northern Nigeria to accept polio vaccination. A study on breastfeeding in Burundi, which was actually conducted by one of my former students at the George Washington University, showed that the duration of breastfeeding actually depended on, how long the women thought God wanted them to breastfeed, whether they were Muslim, or they were Christians, or they practiced local religions. And this was highly instructive because what it meant was that, religious and community leaders in the village, could then be instrumental, in helping to encourage the women to breastfeed for longer. Finally, let me say and remind people that my economist friends would probably also encourage us, very strongly, to look at economic approaches to changing behaviors such as taxing tobacco and alcohol, and offering cash incentives to women to get delivered birth in hospitals. There's very good evidence that the higher the price of tobacco through taxation, the less people will consume it. There is equally good evidence that the same is true for alcohol, and there have been a number of countries that have used conditional cash transfers to encourage women, for example, to engage in certain practices, like giving birth in hospitals, and they've led to substantial increases in those practices. So, Rachel, I'm ready for another one. Wonderful. Our next question from a learner is, "Can you discuss briefly the impact of food on global health? Could you also suggest reliable resources outlining the impact of food and nutrition on global health?" This is a really important question, as the others have been as well. Nutrition is fundamental to human health, and we know that poor nutrition is among the leading risk factors for ill health. And yet for many years, to be honest with you, people working in global health, focused attention on ensuring appropriate breastfeeding, hygienic introduction of complementary foods, and micronutrient supplementation, all of which are fundamentally important. However, their work was rarely integrated with food policy people. There was the micronutrient types over here, if you don't mind my caricaturing it slightly, and caricaturing many of my good friends slightly, and there were the food policy people over here, and they really didn't work together very much. But I'm happy to say, that in the last several years, many countries, and the global community as a whole, is doing much, much better at understanding and at addressing agriculture and food policy issues as they seek to enhance the nutrition of different populations. And along these lines, and given the question about resources, I want to encourage everyone to now faithfully read the Annual Global Nutrition Reports. They bring out some of the most important food policy issues and how they affect nutrition, especially in low and middle-income countries, and they do an excellent job, in my view, of highlighting a number of different kinds of nutrition interventions, both direct and less direct, and how they might enhance the nutritional status of people in a wide range of countries. Rachel, I'm ready for the next one as well. Wonderful. Our next question is about neglected tropical diseases and communicable diseases. So, "How much attention should national policy makers pay to neglected tropical diseases compared to HIV, TB, and malaria?" That's a good question about priority setting in health. And, let's begin by looking at the burden of disease. So the burden of disease among these diseases is highest for HIV, then comes malaria, and then comes tuberculosis. The burden [inaudible] of the neglected tropical diseases, when you take them together, is about two-thirds of the burden of TB. There's no question but the burden of disease is one among several criteria for prioritizing attention to a disease. However, we also want to see if there are ways of addressing diseases in doable, sustainable, and fair ways that pay, for example, particular attention to the most marginalized populations. We may also want to prioritize the disease because of especially significant disabilities that it causes, or the fact that especially poor people get this disease disproportionately. In the end, all four diseases are important, and it's very likely that most countries will put a high priority on all of them, including neglected tropical diseases, given the size of their burden, their effect on the poor, and the extent to which they cause disability. And the fact that they can be addressed in cost-effective, doable, and sustainable ways. Wonderful. Our next learner writes, "I am from South Africa, where every second eight women die from the HPV virus, but no one around me knows what the solution is. What would be a viable solution to this?" HPV, or the human papillomavirus, is sexually transmitted. It's very widespread, and it can cause cervical and other cancers. There's no cure for the virus itself. However, very, very importantly, there is a vaccine against some strains of the virus. That vaccine is being used more and more widely throughout the world, including in low and middle-income countries. In most countries, as recommended by the World Health Organization, the primary target group for the vaccine is adolescent girls, nine to 14 years of age, who we're trying to get the vaccine to prior to their sexual debut. However, in some countries, some countries are recommending that the vaccine also be given to young boys, young men. To address the effects of HPV, or human papillomavirus, it's also recommended that genital warts and cervical pre-cancer be treated, and that efforts be made to diagnose HPV-related cancers as early as possible in the hope that they can be treated effectively before it's too late. In addition, more monogamous sex and the use of condoms can reduce the spread of HPV, although it's important to note that HPV can infect areas not covered by the condom. So the shortest answer is, there's an effective vaccine against several of the strains of HPV, and it's important that more and more countries try to ensure that children, before their sexual debut, get immunized with this vaccine. And I think, Rachel, I think there's one more, right? Yes. Our final question is as follows, "Author William Gibson once said, 'The future is already here - it's just not very evenly distributed.' What do you believe are the obstacles to better distribution of new medicine and technology, and what are the best ways to tackle those obstacles?" This is another excellent question since, equity issues, and fairness issues, and ethical priority setting in health and in global health, are so central to everything that we talk about in this course, The Essentials of Global Health. Indeed, there is a number of constraints to the uneven distribution of medicines and technology. You know, first, the development of these medicines and medical devices, vaccines, diagnostics is largely in the hands of companies that are profit oriented. And firms don't believe that they can earn a sufficient return from the development of such products oriented toward the health needs of poor people in poor countries, and therefore, they're not undertaking so many of these investments. Second, the health systems of a substantial number of countries, especially the lower income countries, have a very uneven provision of health services of all types. It's better in urban areas than in rural areas, it's better among better-off citizens than among less well-off citizens, and often, for a range of reasons, majority groups, majority ethnic and linguistic groups, have better services than minority groups do. Third, many people lack, as you know, especially in low and lower-middle income countries, the means to purchase medical services, medicines, and medical equipment. Now, there's no easy way to address these, and a variety of related constraints, to make the provision of vaccines and medicines, for example, more equitable. However, a number of efforts are underway, at the country level and globally as well, that show substantial promise for doing some of this much better. These include, for example, the establishment of product development partnerships, patent pools, the creation of the International Financing Facility for Immunization, and the advanced market commitments, which also works on vaccines. We have to say drug donation programs have been around for a substantial period of time, and they continue to be very, very important in a number of areas especially, for example, in helping to address neglected tropical diseases. In addition, substantial progress has been made through global cooperation, in lowering the price of and expanding access to HIV drugs. And lastly, I'd say the Affordable Medicines Facility for Malaria showed really interesting promise in my view, and I think in the view of those who evaluated it, when it was essentially suspended for what looks like kind of global political reasons. And yet, other efforts like that one might turn out to be valuable and might be helpful to improving the fair and more equitable access to medicines, medical devices, drugs, and vaccines, and diagnostics. So thank you again to all of the learners who so graciously submitted questions. Thanks to all of those who voted for which questions we ought to be answering. My thanks to Rachel for so graciously asking the questions on your behalf. We hope that you found this session interesting and engaging, and we look forward to other opportunities to have office hours with you in the future. Thanks again.